Figure 4:

Reverse Warburg effect.

Cancer associated fibroblasts (CAFs) form spheroids with cancer cells shed into the peritoneal cavity, forming “Metastatic Units” (MU). Autophagy of fibroblasts provides cancer cells with nutrients and macromolecular building blocks. CAFs support energy metabolism of cancer cells by supplying them with lactate and amino acids. Aerobic glycolysis in cancer cells is more efficient (mitochondrial oxidation: 32 molecules ATP/molecule Glucose; aerobic glycolysis: 4 molecules ATP/molecule Glucose) than anaerobic glycolysis (2 molecules ATP/ molecule Glucose). MU facilitate resistance of cancer cells to anoikis (12).